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Exploring the role of women's autonomy in contraception uptake among rural Indian women: A temporal approach in four states

Kekre, Priya (2012)
Master's Thesis (82 pages)
Committee Chair / Thesis Adviser: Girard, Amy Webb
Committee Members: Stephenson, Robert
Research Fields: Health Sciences, Public Health
Partnering Agencies: Emory University schools, faculty or affiliated programs
Keywords: contraception; women's autonomy; India
Program: Rollins School of Public Health, Hubert Department of Global Health
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Background: India's reproductive health profile is marked by stark regional variations with an overall pattern of southern states faring better than their northern counterparts in fertility and contraception outcomes. Past research has hinted that the prevailing gender norms in these regions may explain the differences, with recent studies specifically examining the role of women's autonomy on outcomes such as contraception use. However, majority of these studies are cross-sectional and often lack the regional diversity essential for India's context. Objective: This study attempts to fill the aforementioned gaps in research. The objective of this study is to investigate the temporal influence of women's autonomy, using a multidimensional measure, on contraception uptake in rural India in four diverse states: Bihar, Jharkhand, Maharashtra and Tamil Nadu. Methods: Prospectivedata from two linked studies were used for analysis: India's NFHS-2, conducted in 1998-1999 and a follow-up study for a subgroup of women carried out in 2002-2003. Primary exposures included three dimensions of autonomy: financial autonomy, mobility autonomy and decision-making autonomy. Logistic regression models were used to identify associations between contraception uptake at follow-up and each autonomy dimension, in the overall sample and in state-stratified samples. Results: Of the overall sample, only 28% of women reported contraception uptake at follow-up. Contraception uptake was significantly higher among those women who reported increased financial autonomy over time (OR=1.55 95 % CI= 1.15-2.09) compared to those who reported low financial autonomy at both points. In Maharashtra, women with high decision-making autonomy at both points were more than twice as likely to use contraception compared to those with low decision-making at both points (OR=2.67, 95% CI =1.19-6.00). Changes in decision-making autonomy and mobility autonomy were not significantly associated with contraception uptake in the overall sample. Conclusion: Findings underscore the need to increase women's economic independence with strategies aimed at improving rural women's access to and control over finances as well as savings-oriented financial support programs. Additionally, this study stresses the importance of community-based interventions aimed at improving girls' and women's education and negotiation skills at the household level to positively influence their reproductive health.

Table of Contents

TABLE OF CONTENTS -- CHAPTER I: INTRODUCTION, 1 -- CHAPTER II: LITERATURE REVIEW, 5 -- 1. The Evolution of Indian Reproductive Health Policy, 5 -- 2. Reproductive Health Outcomes in India, 9 -- 3. The Role of Women's Autonomy, 18 -- 4. Studies Examining the Influence of Autonomy on Contraception, 25 -- 5. Summary of Literature Review, 32 -- CHAPTER III: METHODS, 33 -- 1. Study Objectives, 33 -- 2. Study Setting, 33 -- 3. Data and Study Population, 36 -- 4. Measures, 37 -- 5. Analysis, 40 -- CHAPTER IV: RESULTS, 42 -- 1. Demographic and Socioeconomic Patterns, 42 -- 2. Autonomy Distributions and Trends Across States, 44 -- 3. Autonomy and Contraception Uptake, 47 -- 4. State-specific associations between Autonomy Changes and Contraception Uptake, 48 -- CHAPTER V: DISCUSSION, 51 -- 1. Limitations and Strengths, 56 -- 2. Recommendations, 59 -- 3. Conclusion, 61 -- REFERENCES, 63 -- APPENDIX A: TABLES AND FIGURES, 67


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